Amanda's Care Home II, LLC

Based on record review and interview, the manager failed to ensure the health care institution administered a training program for all staff regarding fall prevention and fall recovery that included initial training and continued competency training, for three of four personnel sampled. The deficient practice posed a health and safety risk for residents. Findings include: 1. A review of E1's personnel record revealed documentation of fall prevention training completed on August 20, 2024. However, documentation of completed fall recovery training was not available for review. 2. A review of E2's personnel record revealed documentation of fall prevention training completed on February 27, 2024. However, documentation of completed fall recovery training was not available for review. 3. A review of E3's personnel record revealed documentation of fall prevention training completed on August 21, 2024. However, documentation of completed fall recovery training was not available for review. 4. In an interview, E1 acknowledged the facility failed to administered a training program for all staff regarding fall prevention and fall recovery.

Based on observation, documentation review, and interview, the manager failed to ensure documentation was maintained of the caregivers and assistant caregivers working each day, including the hours worked by each. The deficient practice posed a risk as there was no documentation to identify the staff that was present each day to ensure the health and safety of residents. Findings include: 1. While on-site for the compliance and complaint inspection, the Compliance Officer observed E2 and E3 working at the facility. 2. A review of the facility's personnel schedule for February 10, 2025, revealed E2 was not scheduled to work and provide services at the facility. However, the schedule was corrected while the Compliance Officer was on-site. 3. In an interview, E2 reported the schedule change was last minute. E1 acknowledged documentation of the caregivers working each day, including the hours worked by each, was not accurate.

Based on record review and interview, the manager failed to ensure that a resident provided evidence of freedom from infectious tuberculosis (TB) before or within seven calendar days after the resident's date of occupancy, for one of two residents sampled. The deficient practice posed a potential illness risk to residents. Findings include: 1. A review of R2's medical record revealed evidence of freedom from infectious TB. However, the evidence was not dated within seven days after R2's date of occupancy. 2. In an interview, E1 acknowledged R2's medical record did not include evidence of freedom from infectious TB within seven days of R2's date of occupancy.

Based on record review and interview, the manager failed to ensure that before or at the time of acceptance of an individual, the individual submitted documentation that was dated 90 calendar days before the individual was accepted by the assisted living facility and included whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints and was dated and signed by a medical practitioner, for one of two residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R2's medical record revealed a document titled "Physician Admission Orders." This document revealed whether or not R2 required continuous medical services, continuous or intermittent nursing services, or restraints and was signed and dated by a registered nurse or medical practitioner. However, the document was dated after R2's date of acceptance by the facility. 2. In an interview, E2 acknowledged R2's medical record did not contain the required documentation that was dated 90 days before R2 was accepted by the facility.

Based on record review and interview, the manager failed to ensure that a medication administered to a resident was administered in compliance with a medication order, for one of two residents sampled. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. A review of R1's medical record revealed a medication order for Midodrine 5 milligrams (mg), 1 tablet every morning, noon and 6:00 PM, hold for systolic blood pressure (SBP) greater than 101. 2. A review of R1's medication administration record for January 2025 revealed Midodrine 5 mg was held from administration to R1 on the following dates and times: - January 9, 2025 at 8:00 AM; - January 11, 2025 at 12:00 PM; and - January 24, 2025 at 6:00 PM. However, R1's SBP readings on the aforementioned dates and times indicated the administration of Midodrine 5 mg was required. 3. In an interview, E1 acknowledged medication administered to R1 was not administered in compliance with a medication order. 4. This is a repeat citation from the compliance inspection conducted November 2, 2023.

Based on record review and interview, the health care institution's chief administrative officer failed to ensure training and education related to recognizing the signs and symptoms of tuberculosis (TB) was provided annually to individuals employed by the health care institution, for two of three personnel sampled. The deficient practice posed a potential illness risk to residents. Findings include: 1. A review of E1's personnel record did not include documentation of annual training on recognizing the signs and symptoms of TB. Given E1's date of hire, this documentation was required. 2. A review of E3's personnel record did not include documentation of annual training on recognizing the signs and symptoms of TB. Given E3's date of hire, this documentation was required. 3. In an interview, E1 acknowledged E1's and E3's personnel records did not include documentation of annual training on recognizing the signs and symptoms of TB.

Based on documentation review, observation, and interview, the governing authority failed to designate, in writing, a manager who had either a certificate as an assisted living facility manager issued under A.R.S. \'a7 36-446.04(C), or a temporary certificate as an assisted living facility manager issued under A.R.S. \'a7 36-446.06. The deficient practice posed a risk to the health and safety of residents as there was not a qualified manager to implement policies and procedures or provide direction to personnel. Findings include: 1. A review of Department documentation indicated O1's appointment as manager ended effective October 26, 2023. There was no documentation of a new manager appointed. 2. In an on-site compliance inspection conducted November 2, 2023, E1 reported O1 was the facility's manager. 3. The Compliance Officer observed a copy of O1's manager license was posted on the premises with an issue date of January 10, 2023. 4. In an interview, the Compliance Officer asked for further clarification regarding the facility's manager. E1 reported the facility did not currently have a manager and was in the process of interviewing for a new one. 5. In an interview, E1 acknowledged the governing authority failed to designate, in writing, a manager who had either a certificate as an assisted living facility manager issued under A.R.S. \'a7 36-446.04(C), or a temporary certificate as an assisted living facility manager issued under A.R.S. \'a7 36-446.06. E1 thought E1 had 30 days to find a new manager.

Based on record review and interview, the manager failed to ensure a resident's medication was administered in compliance with a medication order for one of two residents sampled. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. A review of R2's medical record revealed a service plan dated August 17, 2023. The service plan indicated R2 received medication administration. 2. A review of R2's medical record revealed a medication order dated June 18, 2023 for Losartan Potassium 25 milligrams (mg), one tablet every morning - hold for SBP less than 110 mm HG. 3. A review of R2's medical record revealed a blood pressure chart that documented R2's blood pressure each day. R2's systolic blood pressure measured below 110 mm HG on the following days with the following readings: -October 21, 2023: 104/51; -October 24, 2023: 103/44; -October 25, 2023: 86/44; -October 29, 2023: 96/52; and -November 2, 2023: 108/79. 4. A review of R2's medical record revealed a medication administration record (MAR) for the months of October 2023 and November 2023. The MAR indicated R2 received medication administration of Losartan 25 mg every day from October 1, 2023 to November 2, 2023, including the aforementioned dates where R2's blood pressure measured below 110 mm HG. 5. In an interview, E6 reported the Losartan was not held on November 2, 2023 (the day of the inspection). In addition, E1 believed the Losartan was also not held on the aforementioned days in October 2023. 6. In an interview, E1 acknowledged R2 did not receive medication administration for Losartan 25 mg in compliance with a medication order.

Based on document review, observation, and interview, the governing authority failed to notify the Department according to A.R.S. \'a7 36-425(I), which required immediate notification to the Department in writing, identifying the name and qualifications of the new manager when there was a change in the manager. Findings include: 1. A review of Department records indicated O1's appointment as manager ended December 2, 2022. There was no documentation of a new manager appointed. 2. In an on-site complaint investigation, E1 reported E1 had been appointed manager effective January 1, 2023. 3. In an interview, E1 acknowledged the Department was not notified of a change in the manager. E1 reported not knowing a change in manager required immediate notification to the Department in writing.